Author Information

Bruno Ramos Nascimento,

Fabio N. Demarqui,

Milena Marcolino,

Daniel Chamie,

Antonio Ribeiro and

Marco Costa

Introduction

Much effort has been made to understand the mechanisms and to develop therapies to prevent progression of atherosclerosis. Intravascular ultrasound (IVUS) has been widely used to evaluate plaque progression in response to specific therapies, but there has been no systematic analysis of pooled data focused on the progression pattern.

Objective

To investigate the pattern of coronary plaque volume progression over time by pooling data from prospective clinical trials utilizing serial IVUS imaging.

Methods

A Medline search was performed with 6 combinations of MeSH terms including “plaque”, “progression” and “regression”, to identify trials that evaluated volumetric coronary plaque progression by IVUS, at least 2 points in time. Study arms were pooled, and a multivariate regression model was adjusted, considering the percent plaque volume change (%PVC) as the response, and follow up (FU) time and other relevant risk factors as independent variables.

Results

The search returned 1075 titles; 157 abstracts and 35 papers remained after exclusions, totaling 8327 patients in 73 study arms (24 control and 49 treatment), with a mean FU time of 16 (0.6 to 36) months. 18 papers were statin trials; there was significant plaque regression 27 arms (36.9%), and progression in only 8. In the univariate analysis (all arms pooled), there was no linear association between %PVC and FU time (β = 0.161, p = 0.274), and significant association between statin test and % change in LDL (%LDLDif) with %PVC (β = −8.339, p < 0.001 and β = 0.213, p < 0.001). Considering only the control arms, none of the variables associated with %PVC. In the multivariate analysis, FU time also showed no linear association with %PVC (β = 0.071, p = 0.838). The variables associated with %PVC were statin test, %LDLDif and baseline LDL (β = −5.986, p = 0.027; β = 2.912, p = 0.049 and β = 0.207, p < 0.001).

Conclusion

There seems to be no linear association between %PVC and FU time (with similar findings for the control arms), suggesting that atherosclerotic evolution is not linear in a moderate to high risk population in a time frame of 16 months. The use of statins and the percent change in LDL have significant negative association with plaque progression.

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